Approach to a fever (0-60 days) Quiz: Ace Your Exams
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A previously healthy 24-day-old boy is brought to the emergency department for new-onset fever over the last 24 hours. Parents report that the prior evening the patient was experiencing poor feeding and lethargy. He normally wakes every 3 hours to feed, but last night he slept for a 7-hour interval. The patient has a 2-year-old brother who is in daycare. Temperature is 38.6°C (101.5°F), pulse is 180/min, respirations are 38/min, blood pressure is 85/50 mmHg, and oxygen saturation is 99% on room air. On physical examination, the infant appears fussy but consolable. The anterior fontanelle is open and flat. Cardiopulmonary examination is normal. Laboratory results are shown below. The culture results are pending. Which of the following is the best next step in management?
| Laboratory value | Result |
| Complete blood count (CBC) | |
| Hemoglobin | 13.9 g/dL |
| Hematocrit | 40.9% |
| Leukocyte count | 21,200/mm3 |
| Platelet count | 370,000/mm3 |
| Neutrophils | 45% |
| Eosinophils | 3% |
| Basophils | 0% |
| Lymphocytes | 46% |
| Monocytes | 7% |
| Urinalysis | |
| Leukocyte esterase | Negative |
| Nitrite | Negative |
| pH | 6.8 |
| Protein | Negative |
| Blood | Negative |
| Specific gravity | 1.010 |
| Ketones | Negative |
| Glucose | Negative |
| Bilirubin | Negative |
| Inflammatory markers | |
| C-reactive protein (CRP) | 7 mg/dL |
| Procalcitonin (PCT) | 1.1 ng/mL |
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